Provider Demographics
NPI:1912100934
Name:DELAURO, MICHAEL STEPHEN (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:DELAURO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FALLS BASHAN RD
Mailing Address - Street 2:
Mailing Address - City:MOODUS
Mailing Address - State:CT
Mailing Address - Zip Code:06469-1231
Mailing Address - Country:US
Mailing Address - Phone:203-314-9078
Mailing Address - Fax:203-579-3693
Practice Address - Street 1:2514 BOSTON POST RD
Practice Address - Street 2:SUITE 8 C
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1338
Practice Address - Country:US
Practice Address - Phone:203-314-9078
Practice Address - Fax:209-579-3693
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist